Saudi Arabia officials confirm another MERS case
Saudi Arabia's Ministry of Health (MOH) today reported another MERS-CoV case, the fourth case in September.
The new MERS-CoV (Middle East respiratory syndrome coronavirus) case involves a 39-year-old man from Al Hofuf in the eastern part of the country. The man had contact with a camel, the most common primary risk factor associated with contracting MERS.
As of Sep 19, the WHO's Eastern Mediterranean regional office said that, since 2012 there have been 2,468 MERS cases, at least 850 of them fatal. The vast majority of cases have been in Saudi Araba.
Sep 30 Saudi MOH report
With 2 more cases, US measles outbreak grows to 1,243
The Centers for Disease Control and Prevention (CDC) today said it has recorded 2 more measles cases in the past week, raising 2019's total to 1,243 cases, the most in any year since 1992 and since the disease was declared eliminated from the United States in 2000.
Thirty-one states have confirmed measles cases, but more than 75% of this year's cases have been in New York state.
As of last week, a measles outbreak in Rockland County, New York, with 312 cases, was declared over; Rockland County's outbreak needed to end before Oct 2 to avoid losing the country's measles-free status. The CDC said that today marks 42 days since the last case was identified, which represents two transmission cycles without any new cases.
The CDC is tracking another measles outbreak in New York, unrelated to the one in Rockland County. The outbreak—the only one still ongoing—is identified only as New York State #2 in today's update.
Sep 30 CDC update
More evidence rotavirus vaccine protects kids from severe illness
A new study in JAMA Network Open offers more evidence that the rotavirus vaccine reduces emergency room visits and hospitalizations among US children.
Researchers conducted a case-control study that included 1,193 children under the age of 5 years who had lab-confirmed rotavirus infections paired with 9,620 controls who had acute gastroenteritis; all children were seen in seven hospitals from Nov 1, 2009, through Jun 30, 2016. Medical records were used to determine rotavirus vaccine status for patients, and stool specimens confirmed rotavirus diagnosis.
"Of the 1,193 rotavirus cases in our analysis, 711 (60.0%) had received at least 1 dose of rotavirus vaccine. Of the 9,620 controls, 8,484 (88.2%) had been similarly vaccinated," the authors said.
At least one dose of rotavirus vaccine was 82% protective against rotavirus-associated inpatient visits and 75% protective against rotavirus-associated emergency department visits. The vaccine was most protective against severe illnesses, which the authors called a gradation in vaccine effectiveness by severity. In the combined clinical setting, any dose of rotavirus vaccine was 65% effective against mild infections, 81% against moderate infections, and 91% against severe infections, they said.
"Our vaccine effectiveness assessment supports that RV5 and RV1 rotavirus vaccines continue to perform well in the United States and are associated with the prevention of inpatient visits, severe infections, and among younger children," the authors concluded.
Sep 27 JAMA Netw Open study
Study: Shorter rabies post-exposure vaccine course stacks up well
A shortened rabies post-exposure prophylaxis based on a regimen used for decades by the Thai Red Cross provides as strong of an immune response as the longer regimen, researchers based at the Pasteur Institute in Cambodia reported late last week in The Lancet Infectious Diseases.
The group studied the shorter regimen to assess if it might be a way to improve timely access to the vaccine, especially in light of a global goal to eradicate canine-related rabies in humans by 2030.
For the observational cohort study, the scientists measured rabies virus neutralizing antibody titers in 116 people bitten by dogs who had lab-confirmed rabies from April 2016 to February 2018 and 20 controls. The patients were referred to a rabies prevention clinic at the Pasteur Institute, where they received two intradermal injections of post-exposure prophylaxis on days 0, 3, 7, and 28, with or without rabies immunoglobulin.
No significant difference in neutralizing antibody concentration in people bitten by rabies-positive dogs were seen between days 28 and 42, after titers had reached a plateau. The titers reached didn't seem affected by immunoglobulin use, age, sex, nutrition status, body mass index in adults, or dog infection status. Titers did not increase in the 2 weeks after the last injection, and all patients were alive after 1 year.
The researchers concluded that the fourth vaccine session on day 28 provided no additional benefit and that prophylaxis can be streamlined to a two-dose, three-session 1-week regimen to boost post-exposure prophylaxis coverage at no risk to patients.
In a related commentary in the same issue, a US and South African expert wrote that the compelling data help identify the best use of post-exposure prophylaxis. They said as rabies vaccines have improved in potency and safety, the intradermal route has become a strategy to explore immunogenicity, dose-sparing, and the economic benefits of both pre- and post-exposure prophylaxis, particularly in low- and middle-income countries.
Sep 27 Lancet Infect Dis abstract
Sep 27 Lancet Infect Dis commentary